|The following article features coverage from Kidney Week 2019. Click here to read more of Renal & Urology News’ conference coverage.|
WASHINGTON—Patients on hemodialysis (HD) who have longer dialysis recovery times are at greater risk for hospitalization, according to new findings presented in 3 posters at the American Society of Nephrology’s Kidney Week 2019 meeting.
A total of 98,616 HD patients (mean age 63 years; 58% male) from a large dialysis organization completed the kidney disease quality of life (KDQOL) questionnaire, including this question on dialysis recovery time (DRT): “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Among responders, 25.2%, 19.1%, 17.3%, 15.5%, and 22.9% reported a DRT of less 0.5, 0.5 to 1, 1 to 2, 2 to 4, and more than 4 hours, respectively.
Factors associated with longer DRTs include catheter use; lower serum albumin, sodium, and intact parathyroid hormone levels; and lower Kt/V, ultrafiltration volume by body weight, ultrafiltration rate per hour, and treatment frequency.
Hospital admission rates significantly and progressively increased with each successively longer DRT category. Unadjusted admission rates at 6 months increased from 1.5 persons per year in the lowest DRT category to 1.62, 1.7, 1.76, and 2.0 persons per year for each higher category, respectively. At 12 months, hospitalization rates were 1.61, 1.72, 1.79, 1.86, and 2.11 persons per year, respectively. At 24 months, admission rates were 1.76, 1.85, 1.95, 2.02, and 2.26 persons per year, respectively.
“We have long considered the quality of dialysis care to revolve around achieving specific measurements, including lab results such as estimates of dry weight,” co-investigator Franklin W. Maddux, MD, Global Chief Medical Officer for Fresenius Medical Care, told Renal & Urology News. “These measures, however, can limit the patient’s ability to provide insights into what actually feels best to them individually. Ignoring this patient reported feedback could lead to disconnections between the clinician’s and the patient’s goals and potentially reduce patient adherence.
“Self-reported dialysis recovery time, on the other hand, quantitatively measures how well the patient tolerates hemodialysis and feels afterwards, and it associates with traditional quality measures and outcomes.”
Optimizing HD treatments in a personalized manner may improve health-related quality of life and outcomes, Dr Maddux said. The research team found that higher HD dose and less intradialytic hypotension were associated with longitudinal improvements in DRT.
“Dose optimization strategies with cardiac stability in fluid removal should be tested with the aim to improve how patients feel from and tolerate HD,” according to the investigators.
The studies were sponsored by Fresenius Medical Care.
Read more of Renal & Urology News’ coverage of Kidney Week 2019 by visiting the conference page.
Rigodon Vladimir, Maddux FW, Usvyat LA, et al. Dialysis recovery time as a predictor of hospitalization among incident hemodialysis patients. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10, 2019 in Washington DC. Poster TH-PO267.
Jiao Y, Rigodon Vladimir, Guedes M, et al. Profiles and determinants of dialysis recovery time in incident hemodialysis. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10, 2019 in Washington DC. Poster TH-PO595.
Guedes MH, Maddux FW, Usvyat LA, et al. Higher dialysis dose and less intradialytic hypotension associate with improvements in longitudinal changes in dialysis recovery times. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10, 2019 in Washington DC. Poster TH-PO229.